Earlier in April the Council for Medical Schemes’ (CMS) Council indicated that its to publish a Government Gazette in terms of section 61 of the Medical Schemes Act (131 of 1998) after extensive consultation and consideration of comments received from industry. The aim of the gazette is to declare certain practices pertaining to the selection of Designated Service Providers (DSPs) and mechanism related to the imposition of excessive co-payments, undesirable.
In a notice published in the government gazette on April 23, the CMS declared the following two business practices as undesirable in terms of the Medical Schemes Act:
3.1 The selection by a medical scheme of a healthcare provider or group of providers as the preferred provider or providers to provide to its members the diagnosis, treatment, and care in respect of one or more prescribed minimum benefit conditions, namely as designated service providers without engaging in a fair procurement process which is fair, equitable, transparent, competitive and cost effective. The Council shall publish guidelines on selecting Designated Service Providers (DSPs) for Medical Schemes within 180 days of publication of this notice.
3.2 Imposing a co-payment in terms of Regulation 8(2)(b) that exceeds the quantum of the difference between that charged by the medical scheme’s designated service provider and that charged by a provider that is not a designated service provider of such scheme. This includes any other co-payments, which are unfair to members or beneficiaries or cannot otherwise be numerically justified. The Council will publish guidelines on co-payments within 180 days after the publication of this declaration.
“While the move potentially has implications across the private health-care sector, it will bring particular relief to independent pharmacies shut out of these networks and give patients greater choice in where they purchase their medicines,’ according to a Business Day report.
Click here to read the Business Day article.
